Method and system for determining whether an individual takes appropriate measures to prevent the spread of healthcare-associated infections

ABSTRACT

A system and method that caregivers, central monitoring companies and other persons to monitor whether individuals entering patients&#39; rooms take appropriate steps to mitigate the spread of healthcare associated infections to the patients receiving healthcare services. In one non-limiting the system and method determine whether an individual who has entered the room of a patient has wash his or her hands prior to approaching the patient.

This application claims priority to and the benefit of U.S. ApplicationSer. No. 61/928,485, filed on Jan. 17, 2014, which application isincorporated by reference in its entirety.

1. BACKGROUND

Healthcare-associated infections (HAIs) are infections that are acquiredby patients during the course of receiving treatment for other healthconditions. According to recent studies, one in every twentyhospitalized patients will acquire an infection during the course ofreceiving healthcare treatment for a different condition. In terms ofthe economic impact, studies estimate the overall annual direct medicalcosts of HAIs range between $28.4 and $45 billion. The medical facilitymust typically bear the cost of the HAI, which puts a strain on thefinances of the healthcare provider.

2. SUMMARY AND DEFINITIONS

The disclosure describes a system and method that is directed to theabove problems and provides for a system and method that allowscaregivers, central monitoring companies and other persons to monitorwhether individuals entering patients' rooms take appropriate steps tomitigate the spread of HAIs to the patients receiving healthcareservices. In one non-limiting the system and method determine whether anindividual who has entered the room of a patient has wash his or herhands prior to approaching the patient.

Non-limiting definitions that will be used in describing certainembodiments of the present invention include:

31D Motion and Sound An electronic device that contains one or morecameras capable of Sensor identifying individual objects, people andmotion regardless of lighting conditions, as well as one or moremicrophones to detect audio. The cameras can utilize technologiesincluding but not limited to color RGB, CMOS sensors, infraredprojectors and RF-modulated light. They may also contain microprocessorsand image sensors to detect and process information both sent out andreceived by the various cameras. The electronic device can calculate ifthere has been a change in location of a person or object of interestover a period of time. As a non-limiting example, a person's right kneecan be at time T1 located at coordinates (x1, y1, z1) in a picture frametaken by the camera. At time T2 the right knee is capture by the pictureframe taken by the camera at coordinates (x2, y2, z2). Based on thisinformation, motion, speed and direction can be derived utilizing theelapsed time and comparing the two 3D coordinates over the elapsed time.As opposed to conventional motion sensors, which use captured motion tocontrol a camera, the 3D Motion and Sound Sensor used with the methodand system, uses the camera in order to compute the motion. Thecamera/sensors are preferably continuously on at all times while themonitoring is occurring, regardless of whether a person or object ofinterest is moving or not. The camera preferably views the entire roomor a large portion of the room simply by its placement in a mannersufficient for the room to be visible to the camera. Thus, the cameradoes not require any triggering event to cause the camera to beginrecording video or transmitting video to the other components of thesystem for analysis. As the video camera is recording or otherwisetransmitting video to the other system components at all times duringmonitoring, the electronic device is able to immediately track, captureand/or record the individual's movements at all times within thepatient's room and will be able to provide information as to whether andwhen the individual enters the room, whether and when the individualwashed his or her hands, whether and when the individual approaches thepatients, whether and when the individual leaves the room, etc.Preferably the 3D Motion and Sound Sensor records, captures and/orstreams video. As video is technically made up of individual pictureframes (i.e. 30 frames per second of video), the above reference topicture frames is referring to frames of video. The 3D Motion and SoundSensor is located within the room of the patient being monitored andpotentially just outside of the patient's room. It is connected to thecomputerized communication and computerized monitoring systems via adata connection (TCP/IP or comparable technology). Computerized Acomputer system programmed to monitor activity of the 3D MotionMonitoring System and Sound sensor(s). The computerized monitoringsystem will preferably be located within the patient's room and can beconnected to the centralized monitoring station at the facility but canalso be located at any physical location so long as a data connection(TCP/IP or comparable technology) exists between the computerizedmonitoring system, the computerized communication system, and 3D motionand sound sensor. The computerized monitoring system preferably makesthe determination of a whether and when the individual approaches thepatient and whether and when the individual washed his or her handsprior to approaching the patient based on the data received by the videocamera sensors. Computerized A computer system programmed to facilitatecommunication between Communication System the patient and/or individualand computerized monitoring system in the event it is determined thatthe individual did not wash his or her hands prior to approaching thepatient. This system may include but is not limited to amplifiedspeakers, microphones, lights, monitors, computer terminals, mobilephones and or other technologies to allow for the electroniccommunication to take place. The system can also be designed to notifythe individual that they need to wash their hands also through a textmessage or other electronic message sent to the individual's smartphone, pager, etc. The computerized communication system will preferablybe located within the patient's room being monitored but certaincomponents of the system are mobile by their nature (i.e. mobile phones,pagers, computers) and can also be located at any location so long as adata connection (TCP/IP or comparable technology) exists between thecomputerized monitoring system, the computerized communication system,and 3D motion and sound sensor. Healthcare-associated Infectionsacquired by individuals while receiving healthcare services infection(HAI) in an institutional setting or other location where the healthcareservices are being provided System Database A computer database thatelectronically stores records of all alerts generated, notifications,confirmation requests, responses, reconfirmation requests and any otherdesired information concerning the individual's entry, visit, movements,actions and/or exit within the patient's room. Caregiver A relative,friend, individual, company or facility whose purpose is to provideassistance in the care of daily living activities for individuals whoare disabled, injured, elderly or otherwise in need of assistance.

3. BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a workflow flowchart for monitoring and determining whether anindividual who enters a patient's room takes the appropriate stepsrequired (such as, but not limited to, washing his or her hands) priorto approaching the patient; and.

FIGS. 2 though 14 illustrate various screen shots for configuring thesystem for operation.

4. DETAILED DESCRIPTION OF DRAWINGS

A hand-washing compliance determination for an individual entering apatient's room, prior to the individual approaching the patient isillustrated in FIG. 1. Hand-washing compliance is considerednon-limiting and the system and method can be used to determine if theindividual is compliant with other activities or events prior, during orafter approaching the patient, including, but not limited to, otheractivities that if not undertaken are also know to assist or aid in thespread of HAIs.

Specifically, FIG. 1 shows the workflow for monitoring whether anindividual takes appropriate measures to prevent the spread of HATsthrough the use of 3D Motion and Sound sensors. At step F1a, one or more3D Motion and Sound sensors can be installed in a patient's room, home,hospital room, or other place of temporary or permanent residence. Atstep 1b, the one or more 3D Motion and Sound sensors can be configuredto recognize the patient and other individuals using biometricidentifiers such as facial recognition, height, distance between pointson the body, etc. Alternatively or additionally, a virtualthree-dimensional zone around the patient can be created through asoftware application portion of the system to define an area around thepatient. When the individual is a certain predetermined distance fromthe area or enters the area can be recognized as the event fordetermining that the individual is approaching the patient.

Furthermore, as the system can be programmed to recognize the patient asdescribed above and below, the system can also be programmed to allowthe virtual zone around the patient follow the patient, if the patientmoves around the room or out of the bed. As a non-limiting example, ifthe patient is sitting in a chair within the room, as the systemrecognizes the patient by the biometric identifiers, the locationvirtual zone can be shifted so that it remains around the patient whilethe patient sits in the chair. Accordingly, the determination of whetherthe individual is approaching the patient can be then made based on thepatient's current position in the chair. Other non-limiting examplesinclude the patient being in the restroom, the patient looking out theirwindow, etc.

At step F1c, data from the one or more 3D Motion and Sound sensors aresent to a computerized monitoring system. At step F1d, when (or if) thecomputerized monitoring system detects or determines an individual, whois not the patient, entering the area (such as the virtual areadiscussed above) where a patient resides and approaching the patient itwill make a record in the database of such event and attempt todetermine whether an appropriate measure has been taken by saidindividual to mitigate the spread of infection using one or more methodsincluding but not limited to washing their hands or utilizing handsanitation soaps, gels or lotions. Where the location of the handsanitizer, sink, etc. is outside of the patient's room, one or moreadditional 3D Motion and Sound sensors can be positioned and configuredin order to determine (capture) whether the individual washed and/orsanitized their hands prior to entering the patient's room. Thiscaptured video can also be stored and/or reviewed by the ComputerizedMonitoring System when the system makes its determination. Depending onthe setup of the particular room, the location of a 3D Motion and Soundsensor and/or the coverage area seen capabilities of the 3D Motion andSound sensor, it is possible that a single 3D Motion and Sound sensormay be able to provide information concerning the patient's definedvirtual zone and also provide the information regarding whether theindividual washed his or her hands, etc.

“Washing hands”, “Washing his or her hands”, etc. shall be defined toinclude traditional hand washing, hand sanitizing, etc.

A record can also be electronically entered in a database to record alack of compliance and/or compliance by the individual. Where theindividual is in compliance, the computerized monitoring system willcontinually monitor the data being sent from the one or more 3D motionand sound sensors. Additionally, where a lack of compliance is detected,the computerized monitoring system can be programmed to automaticallybegin, or manually restarted to begin, again monitoring data from theone or more 3D motion and sound sensors. However, at all times duringoperating the 3D motion and sound sensors are on and are capturing,recording and/or streaming video from the room and/or just outside theroom, and do not require a triggering event to initiate recording.

At step F1e, when the system detects that an appropriate action has beentaken by the individual to mitigate the spread of infections, a recordcan be made in the database and audible and/or visible alerts can beissued to the individual acknowledging said compliance. Should theindividual continue to approach or remain in the vicinity of the patientwithout having taken appropriate steps to mitigate the spread ofinfections, an audible and/or visible alert to such individual,notifying said individual of the need to take preventative measures toprevent the spread of infections can be sent by the computerizedcommunication system. Other personal notifications to the individual canalso be sent such as calling the individuals cell phone or smart phone,sending a text message, calling the individual's pager, etc. The systemcan monitor, using gesture recognition, location tracking or othermeasures whether said individual has taken appropriate steps to mitigatethe spread of infection such as washing their hands or utilizing handsanitation soaps, gels or lotions. Particularly with location tracking,virtual zones can also be defined around the hand washing sink, todetermine or detect if the individual entered the sink zone prior toapproaching the patient. It is also within the scope of the invention,to provide a water flow sensor which can be in electronic communicationwith one or more components of the system (i.e. computerized monitoringsystem). The water flow sensor can be provided or in communication withthe water flow line of the sink, such that when the hot and/or coldwater valve of the sink is opened to permit water flow into the sink,the sensor sends a signal representing such information to the system.

At step F1f, if the individual approaching the patient or within closeproximity to the patient fails to comply with the audible and/or visiblewarnings to comply, notification can be given to the caregivers,individual's employer and/or other designated persons that theindividual has failed to comply. Notification of caregivers can be madethrough phone call, text messaging, speakerphone systems, email, orother electronic means of communication. The system database can also beupdated to reflect actions taken.

Where an individual breathing on the patient is also an issue for theparticular patient and/or whether exposure to a patient with aninfectious disease is an issue, the Computerized Monitoring System canalso be programmed to determine whether or not the individual is wearinga mask. The present invention method would go through similar steps ofmonitoring and notification as described above for the “hand washing”monitoring. Though “mask” monitoring preferably would be in addition to“hand washing” monitoring, it is within the scope of the invention thatthe system is also programmed to monitor “mask” monitoring, without“hand washing” monitoring. Similarly, if the individual is required tobe wearing gloves, similar steps can also be performed to confirmcompliance or alert for non-compliance.

FIGS. 2 through 14 illustrate several set up screen shots forconfiguring the virtual zones and alert types. In FIG. 2, the bed zonecan be configured for a given or specific 3D Motion and Sound Sensor. Tobegin configuration, the user can hover over the 3D Motion and SoundSensor video window with the cursor, right-click, select plugin and thenselect configure plug-in. A window will popup showing the 3D Motion andSound Sensors' feed. The user selects the icon for the type of zone theywish to draw, which as a non-limiting example and illustrative purposes,can be a bed zone (See FIG. 3). Similar steps are taken for creating theabove-mentioned virtual sink zone, where provided.

As non-limiting examples, the icons that appear on the screen forselection can include the following symbols shown in FIG. 4. In thisnon-limiting example, in no particular order, some of the icons include,Bed Zone, Auto Bed Zone (Select Patient), Auto Bed Zone (Auto-select),Saved Zones, and Clear All.

As seen in FIG. 5, to place a zone, the user clicks on the screen wherehe or she would like to start the zone. Then, the cursor is moved to thecorner point for zone and clicked again. The user continues to selectadditional points until the zone is drawn to the user's satisfaction.Preferably, the user clicks on the round end point of the beginning ofthe zone to complete the zone (See FIG. 5). When the zone has beencompleted, the zone can appear and a depth range box (i.e. square,rectangle, etc. disposed over the patient on the screen) can be providedon the screen, such as, but not limited to, in the middle of the screenor zone (see FIG. 7), though any location on the screen is consideredwithin the scope of the invention. As seen in FIG. 7, upon completionthe zone appears and has a depth range box preferably in the middle.

As seen in FIG. 6, the user can adjust the depth range for any givenzone. By preferably double clicking on the depth range box or by otherconventional selection methods an Edit Depth window can appear. The usercan enter in the depth ranges (preferably in millimeters (mm) though notconsidered limiting) and then the user can click the Save button or iconwhen done to store the entered values.

If there are any other types of zones to draw for the particular sensor,the above steps are repeated to place the next zone and the depthsetting can be adjusted for each if necessary. Additionally, all zonescan be cleared by clicking on or otherwise selecting the Clear All iconin the toolbar. Once all of the zones/wires are configured, the user canclose the window to finish or can be provided with the option to savethe zone configuration for later use.

As seen in FIG. 8, to access the main settings window, the user canclick or otherwise select the Settings menu and the select Main Settingsfrom the drop-down list. As one non-limiting alternative, the user canclick on the Gear icon (

) or other designated icon in the toolbar to access the main settingswindow.

As seen in FIG. 9, for one non-limiting way to configure a new Alert,the user can select the Alerts tabs and then click on or otherwiseselect the Add button, which can result in the Configure Alert boxappearing on the screen (See FIG. 10). As seen in FIG. 10, under theEvent field, the user can then select the event from the drop down listthat they wish the user wishes to send an alert on. Though not shown,the dropdown list can include an alert for non-compliance with handwashing, non-compliance for not wearing breathing mask, etc.

As seen in FIG. 11, once the Event type is selected, under the Actionfield, the user can select the Action he or she wishes to have thesystem perform when the selected Event is detected or determined. Oncethe Event and Action have be selected the OK button (See FIG. 12) can beselected to save the selected entries.

For certain Actions an additional field may need to be completed tofinish the Action. If the field is required, it can appear below theAction dropdown (See FIG. 13). If no further fields are required, theConfigure Alert box can display N/A (See FIG. 12) or just be blank. Asmentioned above, once all settings are selected, the user clicks orotherwise selects the OK button, which causes the new Alert to be listedin the Alerts tab window. To edit an existing Alert, the user firstclicks on or otherwise selects the Alert and then selects the Editbutton (See FIG. 14). To delete an Alert, first highlight it can thenclick on the Delete button (See FIG. 14).

To add more Alerts, the user clicks or selects the Add button andrepeats the above described steps. Once finished, the user clicks on orotherwise selects the bottom corner OK button to save and close thewindow.

The above described system uses several components, including, but notlimited to:

-   -   1. One or more 3D Motion and Sound Sensors. However, it also        within the scope of the invention to eliminate the sound sensor        and have the functions of the invention be performed with only        3D motion sensors that are continuously on and record, capture        and/or stream video.    -   2. Computerized Monitoring System in electronic communication        with the one or more 3D Motion and Sound Sensors; and    -   3. Computerized Communication System in electronic communication        with the Computerized Monitoring System.

The various components can be in electrical, wired and wirelesscommunication with each other.

The automatic detection and notification or individuals who do not takeappropriate steps to prevent the spread of infections will providesignificant administrative and clinical benefits to caregivers andindividuals alike, including, but not limited to, the following publicbenefits:

-   -   1. Automation of preventative measure detection and notification        of caregivers or other designated entities.    -   2. Reduction in incidences of HAIs.    -   3. Increased survival rate for individuals who are susceptible        to HAIs    -   4. Reduction in costs for hospitalization and medical care        related to HAIs.

All components of the present invention system and their locations,electronic communication methods between the system components,electronic storage mechanisms, etc. discussed above or shown in thedrawings, if any, are merely by way of example and are not consideredlimiting and other component(s) and their locations, electroniccommunication methods, electronic storage mechanisms, etc. can be chosenand used and all are considered within the scope of the invention.

Unless feature(s), part(s), component(s), characteristic(s) orfunction(s) described in the specification or shown in the drawings fora claim element, claim step or claim term specifically appear in theclaim with the claim element, claim step or claim term, then theinventor does not consider such feature(s), part(s), component(s),characteristic(s) or function(s) to be included for the claim element,claim step or claim term in the claim when and if the claim element,claim step or claim term is interpreted or construed. Similarly, withrespect to any “means for” elements in the claims, the inventorconsiders such language to require only the minimal amount of features,components, steps, or parts from the specification to achieve thefunction of the “means for” language and not all of the features,components, steps or parts describe in the specification that arerelated to the function of the “means for” language.

While the invention has been described and disclosed in certain termsand has disclosed certain embodiments or modifications, persons skilledin the art who have acquainted themselves with the invention, willappreciate that it is not necessarily limited by such terms, nor to thespecific embodiments and modification disclosed herein. Thus, a widevariety of alternatives, suggested by the teachings herein, can bepracticed without departing from the spirit of the invention, and rightsto such alternatives are particularly reserved and considered within thescope of the invention.

What is claimed is:
 1. A method for detecting whether an individual whoenters a room of a patient washes his or her hands prior to approachingthe patient, said method performed by a computerized monitoring systemand comprising the steps of: configuring a virtual patient zone definingan area around a patient who is located within a room; receiving livevideo data from one or more 3D motion and sound sensors configured tocapture the live video data from the room; automatically adjusting aplacement of the virtual patient zone within the room based on movementof the patient within a viewing range of the one or more 3D motion andsound sensors such that the virtual patient zone remains around thepatient when the patient moves within the room; determining, from thelive video data, when an individual is a certain distance from thevirtual patient zone or has entered the virtual patient zone;determining, from the live video data, whether the individual washed hisor her hands where it is determined that the individual is within acertain distance from the virtual patient zone or has entered thevirtual patient zone; and electronically initiating an alert ornotification to the individual upon determining that the individual didnot wash his or her hands.
 2. The method for detecting of claim 1further comprising the step of updating a database in communication withthe computerized monitoring system regarding the determination that theindividual did not wash his or her hands prior to being within a certaindistance from the virtual patient zone or has entered the virtualpatient zone.
 3. The method for detecting of claim 1 further comprisingthe step of notifying a previously designated caregiver by electronicmessage regarding the determination that the individual did not wash hisor her hands prior to being within a certain distance from the virtualpatient zone or has entered the virtual patient zone.
 4. The method fordetecting of claim 1 wherein configuring the virtual patient zonecomprises the steps of: receiving a selection of a patient zone from achoice of icons appearing on a screen of a display where the live videofeed from the one or more 3D motion and sound sensors is visible on thescreen; receiving an indication to create an end point where the patientzone begins from a selection on the screen by an electronic cursor;receiving a selection of a corner point for the patient zone from theelectronic cursor selecting the corner point on the screen; andreceiving selections for remaining corner points for the patient zoneand receiving an indication to complete the virtual patient zone fromselections on the screen by the electronic cursor.
 5. The method fordetecting of claim 4 further comprising receiving an indication of adepth range input by a user in a depth range box displayed on thescreen.
 6. The method for detecting of claim 5 wherein the depth rangebox is displayed on the screen within a portion of the completed virtualpatient zone.
 7. The method for detecting of claim 1 further comprisingthe step of configuring the type of alert or alarm to generate in theevent that it is determined that the individual did not wash his or herhands prior to being within a certain distance from the virtual patientzone or entering the virtual patient zone.
 8. The method for detectingof claim 1 wherein the one or more 3D motion and sound sensors areprogrammed to lock on the patient and forward data to the computerizedmonitoring system representing 3D coordinates of body joints for thepatient and a general skeletal outline of the monitored individual.
 9. Amethod for detecting when an individual who enters a room of a patientwashes his or her hands prior to approaching the patient, said methodperformed by a computerized monitoring system and comprising the stepsof: configuring a virtual patient zone defining an area around a patientwho is located within a room, wherein the computerized monitoring systemis located within the room; receiving live video data from one or more3D motion and sound sensors configured to capture the live video datafrom the room; automatically adjusting a placement of the virtualpatient zone within the room based on movement of the patient within aviewing range of the one or more 3D motion and sound sensors such thatthe virtual patient zone remains around the patient when the patientmoves within the room; determining, from the live video data, when anindividual is a certain distance from the virtual patient zone or hasentered the virtual patient zone based on locations of specific bodysegments of the individual being within a certain predetermined orpreconfigured distance from the virtual patient zone or located in thevirtual patient zone; determining, from the live video data, whether theindividual washed his or her hands where it is determined that theindividual is within a certain distance from the virtual patient zone orhas entered the virtual patient zone; and electronically initiating analert or notification to the individual upon determining that theindividual did not wash his or her hands.
 10. The method for detectingof claim 9 further comprising the step of updating a database incommunication with the computerized monitoring system regarding thedetermination that the individual did not wash his or her hands prior tobeing within a certain distance from the virtual patient zone orentering the virtual patient zone.
 11. The method for detecting of claim9 further comprising the step of notifying a previously designatedcaregiver by electronic message regarding the determination that theindividual did not wash his or her hands prior to being within a certaindistance from the virtual patient zone or entering the virtual patientzone.
 12. The method for detecting of claim 9 wherein configuring thevirtual patient zone comprises the steps of: receiving a selection of apatient zone from a choice of icons appearing on a screen of a displaywhere the live video feed from the one or more 3D motion and soundsensors is visible on the screen; receiving an indication to create anend point where the patient zone begins from a selection on the screenby an electronic cursor; receiving a selection of a corner point for thepatient zone from the electronic cursor selecting the corner point onthe screen; and receiving selections for remaining corner points for thepatient zone and receiving an indication to complete the virtual patientzone from selections on the screen by the electronic cursor.
 13. Themethod for detecting of claim 12 further comprising receiving anindication of a depth range input by a user in a depth range boxdisplayed on the screen.
 14. The method for detecting of claim 13wherein the depth range box is displayed on the screen within a portionof the completed virtual patient zone.
 15. The method for detecting ofclaim 9 further comprising the step of configuring the type of alert oralarm to generate in the event that it is determined that the individualdid not wash his or her hands prior to being within a certain distancefrom the virtual patient zone or entering the virtual patient zone. 16.The method for detecting of claim 6 wherein the one or more 3D motionand sound sensors are programmed to lock on the patient and forward datato the computerized monitoring system representing 3D coordinates ofbody joints for the patient and a general skeletal outline of themonitored individual.
 17. A method for detecting when an individual whoenters a room of a patient washes his or her hands prior to approachingthe patient, said method performed by a computerized monitoring systemand comprising the steps of: configuring a virtual patient zone definingan area around a patient who is located within a room; receiving livevideo data from one or more 3D motion and sound sensors configured tocapture the live video data from the room; automatically adjusting aplacement of the virtual patient zone within the room based on movementof the patient within a viewing range of the one or more 3D motion andsound sensors such that the virtual patient zone remains around thepatient when the patient moves within the room; determining, from thelive video data, when an individual is a certain distance from thevirtual patient zone or has entered the virtual patient zone based onlocations of specific body segments of the individual being within acertain predetermined or preconfigured distance from the virtual patientzone or located in the virtual patient zone; determining, from the livevideo data, whether the individual washed his or her hands where it isdetermined that the individual is within a certain distance from thevirtual patient zone or has entered the virtual patient zone; andelectronically initiating an alert or notification to the individualupon determining that the individual did not wash his or her hands. 18.The method for detecting of claim 17 further comprising the step ofnotifying a previously designated caregiver by electronic messageregarding the determination that the individual did not wash his or herhands prior to being within a certain distance from the virtual patientzone or has entered the virtual patient zone.
 19. The method fordetecting of claim 17 wherein configuring the virtual patient zonecomprises the steps of: receiving a selection of a patient zone from achoice of icons appearing on a screen of a display where the live videofeed from the one or more 3D motion and sound sensors is visible on thescreen; receiving an indication to create an end point where the patientzone begins from a selection on the screen by an electronic cursor;receiving a selection of a corner point for the patient zone from theelectronic cursor selecting the corner point on the screen; andreceiving selections for remaining corner points for the patient zoneand receiving an indication to complete the virtual patient zone fromselections on the screen by the electronic cursor.